When dying at home is not an option: exploration of hostel staff views on palliative care for homeless people.

Abstract

The Department of Health in the UK suggest that hostel staff are the most appropriate key workers for their dying homeless residents and that hostel-based palliative care may be the best way forward. However, little is known about the views of hostel staff with regard to this. Semi-structured qualitative interviews were conducted with seven participants from hostels distributed across three counties. A total of 37 specific case studies were discussed involving homeless residents with a wide range of life-limiting or palliative conditions. Eight main themes emerged: understanding palliative care; working with limited medical information; taking responsibility; building rapport; upholding residents' dignity; recognising physical deterioration; managing environmental challenges; role limitations and support needs of hostel staff. Discussion centred around the following four topics: policy, principles and practice of palliative care; professional boundaries as a threat to holism and a hindrance to dignity; the social undesirability and invisibility of homeless people; 'community living' as a barrier to hostel-based palliative care and a new concept of family.